Cargando…

Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion

PURPOSE: To determine the evolution of abdominal aortic aneurysm (AAA) diameter in the presence of persisting type 2 endoleaks (pEL2) following endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: This is a retrospective, single-center, case-control study. All patients with p...

Descripción completa

Detalles Bibliográficos
Autores principales: Hatzl, Johannes, Wang, Vivian, Hakimi, Maani, Uhl, Christian, Rengier, Fabian, Bruckner, Thomas, Böckler, Dittmar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10209501/
https://www.ncbi.nlm.nih.gov/pubmed/35236157
http://dx.doi.org/10.1177/15266028221081079
_version_ 1785046888758640640
author Hatzl, Johannes
Wang, Vivian
Hakimi, Maani
Uhl, Christian
Rengier, Fabian
Bruckner, Thomas
Böckler, Dittmar
author_facet Hatzl, Johannes
Wang, Vivian
Hakimi, Maani
Uhl, Christian
Rengier, Fabian
Bruckner, Thomas
Böckler, Dittmar
author_sort Hatzl, Johannes
collection PubMed
description PURPOSE: To determine the evolution of abdominal aortic aneurysm (AAA) diameter in the presence of persisting type 2 endoleaks (pEL2) following endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: This is a retrospective, single-center, case-control study. All patients with pEL2 (pEL2 group, persisting for > 12 months) between 2004 and 2018 were identified and compared with a 1:1 age- and gender-matched control with no endoleak (control group). Primary outcome measures were freedom from AAA expansion and freedom from AAA shrinkage over time. AAA diameter measurements were performed on computed tomography angiography (CTA). Secondary outcome measures were survival, AAA-related mortality, reinterventions for pEL2, incidence of secondary type 1 endoleaks (EL1), and infrarenal aortic branch vessel anatomy. RESULTS: A total of 773 patients were treated with EVAR for AAA between 2004 and 2018. Of them, 286 patients demonstrated type 2 endoleaks (EL2) in postoperative CTA or intraoperative angiography (37%). Forty-five of 286 EL2 (15.7%) were pEL2 (pEL2 group). Freedom from AAA expansion in the pEL2 group was 100%, 96.7%, 85.2%, and 54.3% after 1, 2, 3, and 4 years, respectively, compared with 100% after 1, 2, 3, and 4 years in the control group (p<0.01). Freedom from AAA shrinkage in the pEL2 group after 1, 2, 3, and 4 years was 95.5%, 90.4%, 90.4%, and 79.1%, respectively, compared with 86.7%, 34.8%, 19.3%, and 19.3% in the control group (p<0.01). Overall survival at 1, 2, 3, and 4 years was 100%, 97.6%, 95.0% and 95.0% in the pEL2 group and 100% at 1, 2, 3, and 4 years in the control group (p=0.17). There were no AAA-related deaths in either group. Patients with pEL2 had a significantly increased number of infrarenal aortic branches (p<0.05, respectively). Eighteen patients (40.0%) in the pEL2 group underwent 34 reinterventions for pEL2, with a median follow-up (FU) of 925 days (0–4173). Clinical success was achieved in 9 patients (50.0%). Four patients (8.9%) with pEL2 developed secondary EL1 after a median FU of 1278 days (662–2121). CONCLUSION: pEL2 are associated with AAA expansion during midterm FU. Further studies are warranted to evaluate the association of AAA expansion due to pEL2 with clinical outcomes to allow recommendations with regard to treatment indications.
format Online
Article
Text
id pubmed-10209501
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-102095012023-05-26 Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion Hatzl, Johannes Wang, Vivian Hakimi, Maani Uhl, Christian Rengier, Fabian Bruckner, Thomas Böckler, Dittmar J Endovasc Ther Clinical Investigations PURPOSE: To determine the evolution of abdominal aortic aneurysm (AAA) diameter in the presence of persisting type 2 endoleaks (pEL2) following endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: This is a retrospective, single-center, case-control study. All patients with pEL2 (pEL2 group, persisting for > 12 months) between 2004 and 2018 were identified and compared with a 1:1 age- and gender-matched control with no endoleak (control group). Primary outcome measures were freedom from AAA expansion and freedom from AAA shrinkage over time. AAA diameter measurements were performed on computed tomography angiography (CTA). Secondary outcome measures were survival, AAA-related mortality, reinterventions for pEL2, incidence of secondary type 1 endoleaks (EL1), and infrarenal aortic branch vessel anatomy. RESULTS: A total of 773 patients were treated with EVAR for AAA between 2004 and 2018. Of them, 286 patients demonstrated type 2 endoleaks (EL2) in postoperative CTA or intraoperative angiography (37%). Forty-five of 286 EL2 (15.7%) were pEL2 (pEL2 group). Freedom from AAA expansion in the pEL2 group was 100%, 96.7%, 85.2%, and 54.3% after 1, 2, 3, and 4 years, respectively, compared with 100% after 1, 2, 3, and 4 years in the control group (p<0.01). Freedom from AAA shrinkage in the pEL2 group after 1, 2, 3, and 4 years was 95.5%, 90.4%, 90.4%, and 79.1%, respectively, compared with 86.7%, 34.8%, 19.3%, and 19.3% in the control group (p<0.01). Overall survival at 1, 2, 3, and 4 years was 100%, 97.6%, 95.0% and 95.0% in the pEL2 group and 100% at 1, 2, 3, and 4 years in the control group (p=0.17). There were no AAA-related deaths in either group. Patients with pEL2 had a significantly increased number of infrarenal aortic branches (p<0.05, respectively). Eighteen patients (40.0%) in the pEL2 group underwent 34 reinterventions for pEL2, with a median follow-up (FU) of 925 days (0–4173). Clinical success was achieved in 9 patients (50.0%). Four patients (8.9%) with pEL2 developed secondary EL1 after a median FU of 1278 days (662–2121). CONCLUSION: pEL2 are associated with AAA expansion during midterm FU. Further studies are warranted to evaluate the association of AAA expansion due to pEL2 with clinical outcomes to allow recommendations with regard to treatment indications. SAGE Publications 2022-03-03 2023-06 /pmc/articles/PMC10209501/ /pubmed/35236157 http://dx.doi.org/10.1177/15266028221081079 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 Lficense (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Clinical Investigations
Hatzl, Johannes
Wang, Vivian
Hakimi, Maani
Uhl, Christian
Rengier, Fabian
Bruckner, Thomas
Böckler, Dittmar
Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title_full Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title_fullStr Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title_full_unstemmed Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title_short Persisting Type 2 Endoleaks Following EVAR for AAA Are Associated With AAA Expansion
title_sort persisting type 2 endoleaks following evar for aaa are associated with aaa expansion
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10209501/
https://www.ncbi.nlm.nih.gov/pubmed/35236157
http://dx.doi.org/10.1177/15266028221081079
work_keys_str_mv AT hatzljohannes persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT wangvivian persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT hakimimaani persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT uhlchristian persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT rengierfabian persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT brucknerthomas persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion
AT bocklerdittmar persistingtype2endoleaksfollowingevarforaaaareassociatedwithaaaexpansion